Chemotherapy

How ESHAP is given

You will usually be given ESHAP during a short stay in hospital, or you may be given it in the chemotherapy day unit. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.

You will see a doctor or nurse before you have chemotherapy. They will ask you about how you have been feeling. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse will give you anti-sickness (anti-emetic) drugs before your chemotherapy. You will also be given extra fluids through a drip before and after chemotherapy. This is to protect your kidneys. You may also be given a drug called mannitol. Mannitol increases the amount of urine your kidneys make.

The chemotherapy and fluids are given through one of the following:

a fine tube that goes under the skin of your chest and into a vein close by (central line)

a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).

The drugs will run through a pump, which gives you the treatment over a set time. Because lots of drugs and fluids are given in ESHAP, you will often have two drips running at the same time.

Before you go home, the nurse or pharmacist will give you drugs to take with you including anti-sickness drugs. Take all your tablets exactly as they have been explained to you. They may also give you steroid eye drops, to help prevent sore eyes. Your doctor or chemotherapy nurse will tell you how and when to use them.

Your course of ESHAP

ESHAP is given over five days.

Day one

The nurse will give you infusions of:

cisplatin over 24 hours

cytarabine over two to three hours

etoposide over an hour

methylprednisolone over 15 to 30 minutes.

Days two, three and four

On each day you will be given:

cisplatin over 24 hours

etoposide over an hour

methylprednisolone over 15 to 30 minutes.

Day five

The cisplatin infusion that began on day four finishes.

You will be given methylprednisolone over 15 to 30 minutes.

After day five

After five days of treatment you will have a rest period with no treatment for either 16 or 23 days. Your doctor will explain how long your rest period will be. This completes a cycle of your chemotherapy treatment. Each cycle takes 21 or 28 days (three or four weeks).

At the end of the 21 or 28 days, you start your second cycle of ESHAP. This is the same as the first cycle. Your doctor or nurse will tell you the number of cycles you are likely to have.

Other ways of giving ESHAP

Some hospitals give cytarabine on day five instead of day one.

Methylprednisolone is sometimes given as tablets that you take by mouth.

If you are given mannitol, you will usually have this on days one to four.

If you have ESHAP as an outpatient you will have the cisplatin infusions through a small portable pump you take home. You will need to return to the hospital each day for the etoposide and methylprednisolone, and to have the cisplatin infusion changed. Your nurse or pharmacist will explain how the pump works and how to look after it.

Having your PICC line put in

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

You may also have some side effects that we haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.

Possible side effects of ESHAP

Reaction to cytarabine

Cytarabine may cause a reaction 6 to 12 hours after it has been given. Signs of a reaction can include:

a high temperature or chills

a rash

pain in the eyes, bones, tummy or chest.

Tell your nurse straight away if you have any of these symptoms.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

Your doctor may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

your temperature goes over 37.5°C (99.5°F)

you suddenly feel unwell, even with a normal temperature

you have symptoms of an infection.

Symptoms of an infection include:

feeling shivery

a sore throat

a cough

diarrhoea

needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days of your chemotherapy. The nurses will give you anti-sickness drugs regularly. If you still feel sick, tell your nurse or doctor. They can change the anti-sickness drug to one that works better for you.

Feeling tired

This treatment will make you feel very tired and you will need a lot of rest. You will get tired easily for some months after treatment too. Gentle exercise, like short walks, can give you more energy. The tiredness will gradually get better.

Effects on your mood

The steroid methylprednisolone can affect your mood. You may feel anxious or restless, or have problems sleeping. Tell your doctor or nurse if you notice any of these symptoms.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

tell your nurse or doctor – they can give you a mouthwash or medicines to help

try to drink plenty of fluids

avoid alcohol, tobacco, and foods that irritate your mouth.

Eye problems

Cytarabine may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help prevent this. It is important to use these as you are told to.

This treatment may also make your eyes more sensitive to light and cause blurry vision. If you have pain or notice any change in your vision, always tell your doctor or nurse.

If you usually wear contact lenses, keep them out on the days you use eye drops or if your eyes are sore. Check with your doctor when it will be okay to use them again.

Skin changes

Cytarabine and etoposide may affect your skin and can cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Hair loss

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Tummy pain

Tell your doctor or nurse if you get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help improve these symptoms.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Changes in hearing

Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears. This is called tinnitus. You may also lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.

Numb or tingling hands or feet (peripheral neuropathy)

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug or delay treatment for a short time. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Effects on the kidneys

Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this.

Before and after each treatment, your nurses will give you extra fluids through a drip. This is to protect your kidneys. It is also important to drink at least 2 litres (3½ pints) of fluids each day.

If you pass less urine than usual, tell your nurse.

Raised levels of uric acid (tumour lysis syndrome)

This treatment causes cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but they may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints, which is called gout.

Your doctor may give you allopurinol (Zyloric®) tablets to help prevent this. Drinking at least two litres (three and a half pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.

Raised blood sugar

Steroids can raise your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms.

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to adjust your insulin or tablet dose.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

a cough

wheezing

a fever (high temperature)

breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Coping with fatigue

Other information about ESHAP

Second cancer

ESHAP can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

pain, redness or swelling in a leg or arm

breathlessness

chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Fertility

Some cancer drugs can affect whether you can get pregnant or father a child. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

Thanks

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